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Notes: Abstract. The aim of this study was to compare changes in periodontal status in a Swedish poplation over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1). gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49%. in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. ID 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (≥4 mm). In 1993, 20%, 42%, and 67% of the individuals m groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with 〉20% bleeding sites and 〉10% sites with periodontal pockets ≥4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.

Notes: Abstract. The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988–91. In 1973, a random sample of 474 dentate adults living in Jönko ping County was examined clinically and radiographically. A questionnaire on demographic and socio-economic status, general health, and dental care habits was also used. During the years 1988–1991, 361 of the individuals examined in 1973 were re-examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20–60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988–91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of 〉20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of 〉20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss 〉20% at ≥6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02–1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non-progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (≥4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02–1.05), 1.01 (1.00–1.03), and 1.03 (1.00–1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06–1.19)), smoking (odds ratio 20.25 (5.07–80.83)), and % pockets ≥4 mm (odds ratio 1.15 (1.04–1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02–9.97) and 8.46 (CI: 1.97–36.37), respectively.

Notes: Abstract Previous in vitro studies have suggested that tetracycline-HCl (TTC-HCl) is adsorbed and actively released from root dentin. The aim of the current study was to evaluate the binding to and release of TTC-HCl from human root dentin surfaces in vivo, and to evaluate the clinical utility of TTC-HCl irrigation as an adjunct to scaling and root planing. Experiment I utilized two contralateral mandibular single-rooted teeth which were examined in four adults with severe generalized periodontitis. One tooth in each patient was carefully scaled and root planed, under local anesthesia, and the other used as an unsealed control. Each subgingival root surface was irrigated for 5 min with an aqueous TTC-HCl solution at a concentration of 100 mg/ml. Gingival crevicular fluid samples were collected on paper strips for the next three weeks. The TTC-HCl concentrations in each sample were determined by the inhibition zone of B. cereus cultured on agar plates. The TTC-HCl concentrations in gingival crevicular fluid collected 15 min after irrigation were 3100±670 μg/ml from the scaled lesions and 4700±1300 μg/ml from the unsealed root surfaces. The antibiotic concentrations decreased logarithmically over the next 7 days; 1500±270 μ/g/ml and 1100±330μ/g/ml at 2 h. 880±350μ/g/ml and 1300±360 μ/g/ml at 6 h and 19±5μ/g/ml and 31±26 μ/g/ml at 1 week for scaled and unsealed root surfaces, respectively. Results for week two and three indicated an average of over 8 μg/ml. The TTC-HCl concentrations in gingival crevicular fluid from scaled and unsealed root surfaces were not statistically different at any time point. The tetracycline irrigation resulted in release of tetracycline at concentrations well above therapeutic concentrations for at least 1 week. Experiment II comprised 11 patients with severe adult periodontitis. All subjects were scaled and root planed prior to baseline measurements. The patients were monitored by the following parameters: probing pocket depth (PPD), probing attachment level (PAL), gingival index (GI) and plaque index (PI). 54 contralateral teeth exhibiting residual pocket depths of 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE88:ges" location="ges.gif"/〉 5 mm were selected. Within each pair identified for the study, teeth were randomly assigned as test or control sites. After baseline measurement, each subgingival root surface was irrigated for 5 min; either with an aqueous TTC-HCl solution of 100 mg/ml (test), or a 0.9% NaCl solution (control). At 3 and 6 months post-treatment, the PI was unchanged for both groups. The GI index was reduced (0.062 〉 p 〉 0.001) in a similar manner for both groups. PPD showed statistically significant (p 〈 0.001) mean/patient decrease of similar magnitudes, 2.3±1.0 mm (test), and -1.6±0.8 mm (control) at 3 months, and -2.1±1.1 mm (test), and -1.4±0.9 mm at 6 months (control), respectively. Also, PAL measurements indicated a statistically significant average gain/patient of 2.1±1.1 mm in the test group (p〈0.00l) and again of 1.2±1.0 mm in the controls (p = 0.002) at 3 months, and 1.8±1.1 mm (test; p〈0.001) and 1.0±0.9 mm (controls; p= 0.005) at 6 months. Comparisons of the changes, between the groups, indicated statistically greater gain of PAL in the test group at both the 3 (p= 0.042) and 6 months (p= 0.034) intervals. These results suggest that TTC-HCl irrigation of root surfaces for long periods of time (5 min) results in a subsequent release of active antibiotic into the gingival fluid at therapeutic levels for at least 1 week. TTC-HCl irrigation resulted in significantly greater attachment gain as compared to scaling and root planing alone over at least a month period of healing.

Notes: Abstract. In this study, potential risk factors for severe periodontal disease were identified in a cross-sectional sample from the county of Jönköping, Sweden, 547 adults 20–70 years of age were categorised clinically and radiographically by level of periodontal disease experience. These levels were used to divide the sample into groups – individuals without any reduction in periodontal bone level (60%) and those with severe periodontal bone loss (13%) – which were then used in univeriate and multivariate logistic regression analyses as dependent variable. Demographic, socio-economic, general health, smoking habits, clinical, and dental care variables were used in the different regression analyses. In the univariate model, age (20–70 years) was found to be correlated with more severe periodontal disease experience (odds ratio: 1.13; 95% CI; 1.10–1.17). The association with periodontal disease was more pronounced for the older age groups (50, 60, and 70 years), A negative financial situation was also related to severe periodontal bone loss when regressed univariately (odds ratio 2.20 [95%: 1.04–4.68]). Moderate-heavy smoking (3=10 cigarettes/day) appeared to be associated with severe periodontal destruction with an odds ratio of 9.78 (95% CI: 3.62–36.42), Of the clinical variables in the univariate model, higher mean levels of supragingival dental plaque and the presence of subgingival calculus were related to more severe periodontal disease with odds ratios of 1.02 (95%: 1.01–1.03) and 2.96 (95% 1.50–5.88), respectively When the same variables were regressed multivariately, age (continuous) (odds ratio 1.17 [95% CI: 1.12–1.22]). moderate-heavy smoking (odds ratio 11.84 [95% CI: 4.19–33.50]), and higher mean levels of plaque (odds ratio 1.02 [95% CI: 1.00–1.03]) remained significant. Light smoking (1–9 cigarettes/day) was not significantly associated with severe periodontal disease in the 2 regression models. The present study demonstrated that smoking, greater age, and higher mean levels of plaque are potential risk factors for severe periodontal disease in this specific population.